青少年癫痫与情绪障碍ppt课件.ppt

* * * * * 在目前的治疗策略中，药物起关键作用。 * * Objective: The authors studied the efficacy of valproate plus lithium and of triple therapy with lithium, carbamazepine, and valproate in refractory bipolar illness. Method: The subjects were 24 bipolar outpatients who had completed an intended 3-year crossover study comparing lithium, carbamazepine, and their combination. Patients entered a 1-year phase of valproate plus lithium because of inadequate response or major side effects, and patients with inadequate responses were offered an additional year of treatment with all three mood-stabilizing drugs. Results: Six (33%) of the 18 evaluable patients had moderate to marked responses to valproate plus lithium; four of these six had not responded to any previous treatment condition. Three of seven patients responded to triple therapy, although only one response was marked. Conclusions: Some outpatients with bipolar disorder refractory to lithium and carbamazepine received clinically relevant prophylactic benefit from valproate when used with lithium or in triple therapy. * * * * 左乙拉西坦是一种新的AED，有其特点，但也有一些不足之处。如┄┄ * 相比之下丙戊酸盐有其独特之处，如┄┄ * * 关注儿童青少年情绪障碍 儿童青少年情绪障碍 儿童青少年期情绪障碍 抑郁、焦虑、恐惧、强迫、羞怯 抑郁：一种不愉快、悲伤、痛苦的体验 焦虑：不祥、不安、担忧为主的情绪体验 恐惧：一种负性情绪，当个体安全遭到威胁时出现 小学生抑郁症状出现率3.4%~11.5% 分离性焦虑障碍：3.5%~5.1% 对分离性场景产生焦虑 学校恐怖、社交恐怖 害怕上学，害怕社交场合 儿童强迫症：1%~2% 反复洗手、重复检查，强迫回忆或强迫性穷思竭虑 儿童青少年情绪障碍的治疗 药物治疗 抗焦虑、抗抑郁药物 苯二氮卓类药、SSRI 心境稳定剂 心理治疗 支持性心理治疗 行为矫正治疗 认知治疗和家庭治疗 癫痫 常见病：患病率4.4‰ 特发性癫痫 儿童及青少年期发病 一般无神经系统阳性体征 神经影像学检查无异常 症状性癫痫 年龄相关性不如原发性的强 较为明确的病因 发作相对较多 脑电图检查背景活动欠正常 可有神经系统阳性体征及影像学异常 沈渔邨. 精神病学. 北京: 人民卫生出版社; 2002,270-279 癫痫所致精神障碍 发作性 感觉、知觉、记忆、思维、精神运动性发作、情绪变化 非发作性 人格改变、智能衰退、神经症、慢性精神分裂症样症状 Sadock, Benjamin J., Sadock, Virginia A. Kaplan Sadocks Comprehensive Textbook of Psychiatry, 8th Edition, 378-382 癫痫所致精神症状 情绪症状常见 发作前 发作时 发作后 焦虑、紧张、易激惹 躁狂抑郁样精神病 Vaaler AE, Morken G, Linaker OM, et al. Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms